ACL Injuries: Trending in the wrong direction

Trending in the Wrong Direction

ACL injuries in female athletes on the rise

PLYMOUTH —

On a recent Saturday night, the U.S. Women’s National Team debuted its 2011 World Cup team in a pre-World Cup friendly match against Japan. Less than 30 minutes after coming onto the field, one of the top players in U.S. history, midfielder Lindsay Tarpley, tore her ACL for the second time in the same knee. She would miss her chance to play in the World Cup.

Across the globe, some of the fittest female soccer players continue to suffer ACL tears. Norway lost one of its top players – Melissa Wiik. The Asian Football Confederation Women’s Footballer of the Year, Australia’s Kate Gill, tore her ACL in early May. Both players will miss the 2011 FIFA Women’s World Cup. Chicago’s Leah Fortune, 20, who plays for the Brazilian Women’s National Team, tore her ACL just minutes into her first-ever match for the senior Brazilian team.

This year in Women’s Professional Soccer, two players – Jordan Angeli, 24, of the Boston Breakers and Lindsey Johnson, 23, of Sky Blue FC – tore their ACLs and will miss the rest of the 2011 season.

“The level of competition is only one of many factors that can contribute to an ACL tear,” said National Strength and Conditioning Association Certified Strength and Conditioning Specialist Dave Gleason, a former Silver Lake soccer standout who runs Athletic Revolution with his wife, Andrea. “Although their fitness level may be high, they may be performing with movement patterns that can be incorrect. When the body moves incorrectly, undue stress is placed on structures such as the ACL.”

If ACL tears can happen to the most fit athletes in the world, what about younger players, college and high school kids?

“I have seen ACL and other soft tissue injuries in young female athletes as young as 12 years old. Many of my colleagues around the country have reported ACL tears younger and younger,” Gleason said. “Unfortunately, many of our new members come to us because of a pre-existing injury. I worked with a women’s college soccer team in the summer of 2009, and I was shocked to see over half the team was either wearing a knee brace or had had an ACL surgery or two.”

Gleason was a four-year starter and co-captain of the Division 1 Silver Lake Regional High School soccer team that brought the school its first-ever state championship. In January 2010, Dave was inducted into his high school’s athletic Hall of Fame as an individual and as a member of the 1988 State championship team. As a Division 2 Second Team All-New England captain for Keene State College, Gleason capped his athletic career and began his professional career in Westchester County, N.Y.

Gleason, the 2010 IYCA Trainer of the Year, has coached young athletes for two decades, dating back to 1989 as a soccer coach to hundreds aspiring soccer players. In the mid to late 90s, he served as a strength coach for some of the most successful young tennis players in New England. He has served as a strength and conditioning coach for private swim club teams and has worked individually with hundreds of children 6-18 years old with a wide ranging ability level.

The youngest person Gleason has seen tear an ACL was a 16-year-old boys’ lacrosse player. On the girls’ side, the number of ACL tears in younger athletes has steadily increased.

“The rise in ACL injuries is due to a variety of reasons,” Gleason said. “The hyper-competitive nature of youth sports does not discriminate against any gender. The rush for more practice, more speed and better conditioning in the absence of proper warm ups, skill development and training programs to prepare a young female athlete for athletics are all contributors to the increase in non-trauma ACL injuries.

Preventative measures

Gleason is running a high school girls’ soccer strength and conditioning program this summer, specifically focusing on ACL prevention. The training program is designed exclusively for young female athletes and will focus on systemic strength training, muscle tissue quality, muscle activation, general preparation, strength technique/movement skill and proficiency, and power execution/systemic strength/movement execution.

“There are several ways to increase injury resistance,” Gleason said. “While no program can guarantee complete prevention, there are three top factors that are a must in order to keep an athlete safe.”

“The hamstring (back of the thigh) and the glute muscles work together to help keep the knee joint in proper alignment during movement,” Gleason said when talking about leg strength. “These muscles must be strong for an athlete to stay safe and well-guarded.”

He pointed to an example called, “Lying Bridges.”

“Hamstring and glute muscles can be strengthened in a variety of ways, but one of the best places to start is by having the athlete lie on their back with knees bent,” Gleason said. “Lift their hips off the ground and ‘squeeze’ their butt muscles.”

For the warm-up, Gleason said, “A proper, well planned warm-up is essential prior to every training session, practice or game. Much more than just taking a lap and stretching, a good warm-up serves to engage the control centers in every joint.”

His example: Balance.

“Warming up should involve a lot of factors, including engaging the control centers of each joint,” Gleason said. “Have the athletes perform one-leg balance exercises as part of the warm-up to ensure that the knee joint is 100 percent ready.”

For jump technique, Gleason said: “Learning how to jump and land is an incredibly important part of keeping athletes safe. More than just doing ‘plyos,’ teaching the proper execution of jumping and landing in paramount. Although jumping is not seen as transferable to all sports, it actually is. Jump training done in the correct manner correlates to the acceleration and absorption forces the body has to deal with when sprinting, stopping and changing direction.”

His example: Instruction.

“As part of the warm up, teach the athletes how to safely and effectively jump and land using toe-off and heel landing strike positions,” he said.

First-hand experience

Manya Makoski, who currently plays soccer for Thor/KA in Iceland’s top-flight league, previously played in Women’s Professional Soccer for the Los Angeles Sol (2009) and was a member of the Atlanta Beat. But during the Beat’s 2010 preseason, Makoski tore her ACL.

But unlike a broken bone, most athletes who tear their ACL are mobile and can put a slight amount of pressure on their knees.

“I was able to walk off the field and walk around that day,” said the 27-year-old from Bridgeport, Conn. “My knee didn’t swell up or hurt until the next day.”

Makoski said, however, she knew something was wrong the moment the tear happened. She recently authored an article for the global women’s soccer publication, Our Game Magazine, called “Mental Toughness,” where she talked about her injury, the mental toll it took on her, and the recovery timeline, which for most athletes can run anywhere from six to 10 months.

“When I tore my ACL it was really weird. I faked to go one way, to the left, planted with my left, to try to go to the right, (and) I just felt it tear, said the former Arizona State University star was on the 2002 U.S. Under-19 World Cup Team that won the FIFA World Championships in Canada. “I immediately went to the ground because I knew I did something bad to my knee. It didn’t hurt at all, and I didn’t hear a pop, but I just knew that it was bad. It was really sickening to feel your ACL tear.”

Recovery

Makoski returned to action earlier this spring, playing soccer competitively on the professional level for the first time in more than a year. During her preseason with Thor/KA she began to feel more comfortable out on the field and started scoring goals left and right.

“I am over a year from my surgery,” she said. “Since recovering ‘fully’ from my ACL tear, I have realized that you are never really fully recovered. Rehab was a very hard mental and physical test for me. It was one of the most grueling things I have had to do in my career. Every day is devoted to your rehab – how you can get stronger, get more range of motion, get more confidence. The more effort and work you put into your rehab, the better off you are going to be in the long run. Even today, I am still focusing on those aspects. But I definitely believe you come out fitter and stronger than you were before because of that rehab. Yes, I may still have to ice my knee after training or going for a run, but I am no less of an athlete because of that.”

Gleason said that the best course of rehab depends on the severity of the injury and taking into account if surgery is needed to fix the tear.

“Often, rehab will include reducing swelling, reestablishing a full range of motion, strengthening the muscles of the front and back of the thigh, as well as muscle sequencing,” he said. “As soon as possible, the athlete needs to engage in activities that are complex in nature, involving several muscle groups, to ensure proper overall function and movement quality,” Gleason said. “An injury of this nature is many times an opportunity to assess other possible dysfunction or movement patterns that could cause issue in the future.”

However, Gleason cautioned people about training programs, and urged that injury resistance is key.

“Beware,” Gleason said. “Not all sports performance training programs are rooted in skill development and injury resistance. Most programs and facilities add to the pressure of performing at a high level for younger and younger athletes. In many ways, young athletes are more dependent on training programs that will deliver coaching, instruction, and a progressive system for making them better. Better performance does not need to be the goal because with the proper training it will be the outcome in addition to injury resistance.”